Basic Information
| Provider Information | |||||||||
| NPI: | 1689116261 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSK | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 LAKE ST | ||||||||
| Address2: | STE. 230 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603011015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 LAKE ST | ||||||||
| Address2: | STE. 230 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603011015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3312219000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2016 | ||||||||
| LastUpdateDate: | 04/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 071009408 | IL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.